Provider Demographics
NPI:1205562667
Name:BUSH, THERESA N (CPHT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:N
Last Name:BUSH
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3031
Mailing Address - Country:US
Mailing Address - Phone:215-382-4260
Mailing Address - Fax:215-382-5603
Practice Address - Street 1:4055 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3031
Practice Address - Country:US
Practice Address - Phone:215-382-4260
Practice Address - Fax:215-382-5603
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician